Headache Characteristics Research Articles

Assessing the influence of migraine on stroke ischemic penumbra

Abstract Introduction There is controversy as to whether migraine affects the behavior of ischemic penumbra during the acute phase of an ischemic stroke, thereby accelerating the formation of cerebral infarction. Objectives To assess whether migraine modifies the existence and volume of the divergence between the areas of diffusion and perfusion in the stroke (the penumbra). Methods This was a prospective cohort study carried out in a hospital in the city of Recife, Pernambuco, Brazil. We included consecutively hospitalized patients with ischemic stroke within 72 hours of symptom onset. A diagnosis of ischemic stroke was made by the presence of a diffusion restriction pattern on the MRI within a compatible clinical context. Patients were assessed by a neurologist who conducted an interview using a semi-structured questionnaire containing questions regarding sociodemographic data, the presence and characteristics of headaches in their lives, the presence and characteristics of headaches related to ischemic stroke and the related clinical condition to ischemic stroke. The headaches presented were classified according to the diagnostic criteria of the third edition of the International Classification of Headache Disorders. The National Institute of Health Stroke Scale and the modified Rankin scale were used. Patients underwent MRI of the brain with diffusion and with perfusion. Results: A total of 221 patients were included, 59.3% of whom were male, and a mean age of 68.2 ± 13.8 years. Ischemic penumbra analysis was performed in 118 patients. There was no association between migraine and the absence of ischemic penumbra (OR: 1.22; CI95%: 0.52 – 2.87; p=0.649; Chi-Square Test). There was no difference in the volume of ischemic penumbra between those with and without migraine. There was no difference in stroke volume between those with and without migraine (1.0; 0.38 – 7.9 cm3... (To see the complet abstract, please, check out the PDF.)

Assessing the influence of migraine on the prognosis of ischemic stroke: a prospective cohort study

Abstract
 Introduction
 There is controversy as to whether migraine implies a poorer prognosis after the stroke. 
 Objectives
 To assess whether migraine implies a poorer prognosis after the stroke.
 
 Methods
 This was a prospective cohort study carried out in a hospital in the city of Recife, Pernambuco, Brazil. We included consecutively hospitalized patients with ischemic stroke within 72 hours of symptom onset. A diagnosis of ischemic stroke was made by the presence of a diffusion restriction pattern on the MRI within a compatible clinical context. Patients were assessed by a neurologist who conducted an interview using a semi-structured questionnaire containing questions regarding sociodemographic data, the presence and characteristics of headaches in their lives and the related clinical condition to ischemic stroke. The headaches presented were classified according to the diagnostic criteria of the third edition of the International Classification of Headache Disorders. The National Institute of Health Stroke Scale and the modified Rankin scale were used. Patients underwent MRI of the brain with diffusion and with perfusion. Patients were assessed by telephone 3 months after the stroke to determine the prognosis.
 Results
 A total of 221 patients were included, 59.3% of whom were male, and a mean age of 68.2 ± 13.8 years. One hundred and seventy-eight patients (178/221; 81%) were assessed 3 months after the ischemic stroke. Migraine was not associated with the stroke prognosis (logistic regression).
 Conclusion
 Migraine is not associated with the prognosis of ischemic stroke.
 Key-Words: Cerebrovascular Disease, Ischemic Stroke, Migraine, Stroke outcome.

Intracranial hypertension secondary to low doses of vitamin A

Introduction Chronic Vitamin A toxicity usually occurs with high doses of Vitamin A intake, usually after using >30,000mcg EA daily for several months. For treatment of skin disorders isused massive doses (50,000 to 150,000 mcg AE daily). Early signs and symptoms can be sparsely distributed rough hair, alopecia of the eyebrows, rough and dry skin, dry eyes and chapped lips. Later, severe headache, intracranial hypertension, and generalized weakness develop. Fractures can easily occur, especially in the elderly. Objective To present a case of intracranial hypertension secondary to chronic intake of low doses of Vitamin A. Method Revision of medical record. Case Woman, 60 years old, thin, presents with worsening headaches for two years. Since childhood, she has had migraine without aura in low-frequency. In the last two years, she has had some changes in headache characteristics, however she still met criteria for migraine. Pain occurred daily and there were four episodes of nocturnal awakenings by pain in the last year. Magnetic resonance imaging of the brain and venous-phase magnetic resonance angiography normal. A cerebrospinal fluid analysis was requested, which showed an opening pressure of 92cmH2O and a closing pressure of 40cmH2O. No futher abnormalities. Acetazolamide 250mg twice a day was started, with intolerance and metabolic acidosis after 3 days of use. It was replaced by topiramate, to which there was also intolerance at a dose of 25mg twice a day for 7 days of use. Asked again by the use of any medine/vitamin, patient revealed that use two capsules of propolis for fourteen years, whose leaflet showed the presence of 300 mcg EA of vitamin A in each capsule of the compound. Patient was advised to discontinue its use and to repeat cerebrospinal fluid analysis in three months, whose opening... (To see the complet abstract, please, check out the PDF.)

Headache in Post-COVID-19 Patients: Its Characteristics and Relationship with the Quality of Life.

Little is known on the characteristics of headaches associated with coronavirus disease 2019 (COVID-19) in Indonesia. The objective of this study was to describe the characteristics of headache in post-COVID-19 patients, and its impact on the patients’ quality of life (QoL), as well as to determine the associated determinants of the poor QoL. A cross-sectional study was conducted in Banda Aceh, Indonesia. The demographic characteristics, clinical symptoms of COVID-19, characteristics of headache, and the QoL were collected and assessed. Headache was diagnosed and characterized using the International Classification of Headache Disorders, version 3 (ICHD-3). QoL was assessed using a Short Form 36 Health Survey (SF-36) tool. A logistic regression model was used to investigate the associated determinants of poor QoL in post-COVID-19 patients. A total of 215 post-COVID-19 patients were included in the final analysis, and 21.4% (46/215) of them had a poor QoL due to headache following COVID-19. Those who were unemployed and who contracted COVID-19 less than three months prior to the study had higher odds of having poor QoL compared to those who were employed and who contracted COVID-19 more than three months prior to the study. Low QoL was also related to headache that occurred less than one month after recovering from COVID-19 (compared to that which occurred longer than one month after); had a high frequency; had a combination sensation of pulsating, pressing, fiery, and stabbing pain; had a high severity score; and had additional symptoms accompanying the headache. In conclusion, headache related to COVID-19 is associated with low QoL among post-COVID-19 patients. A guideline on prevention measures of headache on COVID-19 patients, therefore, needs to be established to avoid long-term consequences.

The Prevalence and Clinical Characteristics of Primary Stabbing Headache.

Objective: This study aimed to determine the prevalence and characteristics of primary stabbing headache in children and adolescents that presented because of headache. Materials and Methods: The medical files of 772 children and adolescents who presented with headache to the Pediatric Neurology Outpatient Clinic at Başkent University between 2012 and 2020 were retrospectively reviewed. In total, 77 patients (9.97%) with primary stabbing headache and those thought to have primary stabbing headache were included in the study. Patient data, including demographic features, headache characteristics, family history of primary headache, electroencephalographic (EEG) findings, and cranial magnetic resonane imaging (MRI) findings, were noted. Results: Age at presentation was <6 years in 16.9% of the patients and onset time of headache was below 3 months in 55.8%. Daily headache attacks occurred in 46.8% of the patients. Headache localization was frontal in 54.5% of patients and bilateral in 68.8%, whereas the quality of headache was undefined in 40.3%. Headache attack duration was seconds long in 37.7% of the patients, attacks occurred at any time of the day in 83.1%, and 80.5% did not have accompanying symptoms. In all, 54.5% of the patients had a negative family history of primary headache. In 95.8% of the patients, EEG findings were normal and cranial MRI findings were normal in 100% of the patients. Conclusion: The prevalence of primary stabbing headache is not rare in children and adolescents. Clinician awareness of the diagnosis and underlying causes of primary stabbing headache should be increased.

Path Analysis Models Integrating Psychological, Psycho-physical and Clinical Variables in Individuals With Tension-Type Headache

Tension type headache (TTH) is a prevalent but poorly understood pain disease. Current understanding supports the presence of multiple associations underlying its pathogenesis. Our aim was to compare competing multivariate pathway models that explains the complexity of TTH. Headache features (intensity, frequency, or duration - headache diary), headache-related disability (Headache Disability Inventory-HDI), anxiety/depression (Hospital Anxiety and Depression Scale), sleep quality (Pittsburgh Sleep Quality Index), widespread pressure pain thresholds (PPTs) and trigger points (TrPs) were collected in 208 individuals with TTH. Four latent variables were formed from the observed variables - Distress (anxiety, depression), Disability (HDI subscales), Severity (headache features), and Sensitivity (all PPTs). Structural equation modelling (SEM) and Bayesian network (BN) analyses were used to build and compare a theoretical (modeltheory) and a data-driven (modelBN) latent variable model. The modelBN (root mean square error of approximation [RMSEA] = 0.035) provided a better statistical fit than modeltheory (RMSEA = 0.094). The only path common between modelbn and modeltheory was the influence of years with pain on TrPs. The modelBN revealed that the largest coefficient magnitudes were between the latent variables of Distress and Disability (β=1.524, P = .006). Our theoretical model proposes a relationship whereby psycho-physical and psychological factors result in clinical features of headache and ultimately affect disability. Our data-driven model proposes a more complex relationship where poor sleep, psychological factors, and the number of years with pain takes more relevance at influencing disability. Our data-driven model could be leveraged in clinical trials investigating treatment approaches in TTH. PerspectiveA theoretical model proposes a relationship where psycho-physical and psychological factors result in clinical manifestations of headache and ultimately affect disability. A data-driven model proposes a more complex relationship where poor sleep, psychological factors, and number of years with pain takes more relevance at influencing disability.

Headache in bone marrow donors and oncohematological patients, who taking granulocyte colony-stimulating factor: incidence and clinical features

The aim of the study was to assess the incidence and clinical features of headache associated with the use of granulocyte colony-stimulating factor (G-CSF) for stem cell mobilization or neutropenia treatment among oncohematological patients and bone marrow donors.Material and methods. A prospective observational uncontrolled study included 39 participants: 20 bone marrow donors (group 1) and 19 oncohematological patients (group 2). We evaluated the incidence and clinical features of headache after subcutaneous administration of G-CSF (filgrastim) at doses of 5 to 10 μg/kg for 2 to 5 days.Results. Headache occurred in bone marrow donors more often compared to patients with hematological malignancies (78.9% vs 35.0%; p = 0.006). There were no significant differences in the time of headache onset, its duration, intensity, features, and localization between two groups. Gender, age, dose of G-CSF, and duration of its use were not associated with headache development in both groups.Conclusion. Headache occurs more often in bone marrow donors than in patients with hematological malignancies. The phenotype of headache associated with G-CSF exposure is not drug-specific and requires further studies on its semiotics.

Therapy for Psychiatric Comorbidities in Patients with Episodic Cluster Headache: A Prospective Multicenter Study.

PurposeTo explore changes of depression, anxiety and sleep disturbance in patients with episodic cluster headache inside and outside the attack period and assess the therapy to improve the treatment.Patients and MethodsWe prospectively recruited 396 patients from 11 specialized headache outpatients and analyzed their headache characteristics, Hospital Anxiety Depression Scale scores, Pittsburgh sleep quality index scores, and the usage of psychiatric medications during as well as 1 month after the attack period.ResultsA total of 220 patients completed the follow-up, 52.73% of whom had anxiety, 47.27% had depression and 49.09% had sleep disturbance inside the attack period. At follow-up, the percentage of these patients significantly decreased to 16.36%, 21.82% and 14.55% in the remission period, respectively (p < 0.05). Antidepressants and mood stabilizers were prescribed to 58.18% of the patients. However, both of the changes of Hospital Anxiety Depression Scale scores after the end of the attack period for anxiety (3.52±2.91 vs 3.32±3.09, p =0.61) and depression (3.41±3.33 vs 2.90±3.58, P =0.28) were comparable in patients with and without taking these medications. Nocturnal onset of headache was positively correlated with Pittsburgh score (OR=8.71), anxiety (OR=2.33) and depression scores (OR=3.56) (p < 0.05).ConclusionDepression, anxiety and sleep disturbance were significantly alleviated after the attack period. However, psychiatric medications showed limited effect on depression and anxiety. Additionally, the nocturnal attack may cause anxiety and depression in episodic cluster headache.

Cough, Cough-Induced, and Primary Cough Headache

Dear Editor, We read the article entitled “Magnetic Resonance Imaging of Leptomeningeal Cyst with Atypical Presentation: Cough-Induced Headache” on the esteemed “Matrix Science Medica” with great interest. Dar et al. presented two adult patients with posttraumatic leptomeningeal cysts presenting as cough-induced headache. The headache worsened on forceful coughing in both individuals. In this context, the presence of growing skull fractures with headache and cough highlights the possible association between this type of headache and cerebrospinal fluid dynamic.[1] Headache associated with coughing is characterized by headaches triggered by a rapid increase in intra-abdominal pressure caused by coughing, sneezing, or straining. It is an uncommon finding with a lifetime prevalence of <1%. Interestingly, the syndrome of cough headache is symptomatic in about 40% of cases, and the majority of these patients have Arnold–Chiari malformation Type I.[2] Herein, we would like to discuss recent studies about this rare condition. Four main mechanisms could explain headaches triggered by cough, which are jugular vein stenosis, cerebrospinal fluid hypervolemia, infection altering vascular tone, and crowdedness of the posterior cranial fossa [Figure 1]. We believe that these mechanisms combined lead to the development of headaches, instead of being separated pathways.Figure 1: Pathophysiological mechanisms related to headache associated with cough. There are four main pathways that are jugular vein stenosis, cerebrospinal fluid hypervolemia, infection alters vascular tone, and crowdedness of posterior cranial fossa. The third version of the diagnostic criteria for primary cough headache of the international classification of headache disordersTakizawa et al. reported a case of an individual presenting with both primary cough headache and headache attributed to temporomandibular disorder. Their report was interesting because headaches associated with referred pain exhibit secondary central nervous system effects that can easily confound clinicians. It is worthy of mentioning that involuntary nonfunctional tooth contact is believed to be an important cause of both types of headaches.[2] Primary cough headaches are mainly observed in adult patients, but cough-induced headaches are potentially symptomatic in the pediatric population. Omata et al. described a 7-year-old boy presenting with powerful cough-induced headaches. Echo examination confirmed right internal jugular vein dilatation during a Valsalva maneuver, and the individual was diagnosed with primary cough headache with internal jugular phlebectasia. Their report brings a new idea about the pathophysiology of this type of headache, which may be associated with the morphology and function of the internal jugular vein.[3] Moreno-Ajona et al. reported a 53-year-old male diagnosed with primary cough headache using indomethacin, which was stopped due to gastroesophageal reflux disease. He was started on noninvasive vagal nerve stimulation (nVNS) using the gammaCore™ device. The individual showed improvement in his symptoms with nVNS, in particular, the parasympathetic reflex arc. This approach has advantages when compared to indomethacin such as good tolerability and safety of neuromodulation.[4] In a recent Chinese respiratory clinic, it was assessed the prevalence, predictive factors, and clinical characteristics of cough headache in 679 patients. The prevalence of cough headache was 18.0% in these coughing patients. The main risk factor for the development of cough headache was age between 31 and 50 years (odds ratio 2.0). Furthermore, cough headache was associated with cough severity. It is noteworthy that headache severity had a positive correlation with cough severity, age, and headache duration.[5] In sum, primary cough headaches are related to a mixture of pathological mechanisms. They are probably more common than we first believed. Moreover, when present in the pediatric population, further evaluation is needed. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

PEDIATRIC HEADACHES: DOES NEUROIMAGING CONTRIBUTE TO DIAGNOSIS?

Objective&#x0D; Headache is a common complaint in childhood.&#x0D; While the etiology is usually benign, such as migraine&#x0D; or tension-type headache, cranial imaging is often&#x0D; performed on patients to identify any missed or serious&#x0D; underlying pathology. In the present study we assess&#x0D; the etiology and clinical characteristics of headaches&#x0D; in children and establish the diagnostic contribution of&#x0D; imaging methods.&#x0D; Material and Method&#x0D; This retrospective study included patients who&#x0D; presented with headaches to the Pediatric&#x0D; Neurology Outpatient Clinic of Süleyman Demirel&#x0D; University Faculty of Medicine between 2019 and&#x0D; 2022. Headache information (frequency, duration,&#x0D; type, characteristics, intensity, localization, and&#x0D; accompanying findings) was obtained, and the cranial&#x0D; imaging results of patients were recorded. Headaches&#x0D; were classified according to the criteria established by&#x0D; the International Headache Society.&#x0D; Results&#x0D; The study included 234 patients aged 2–18 years&#x0D; with a mean age of 12.56 years, of which 64.5% were&#x0D; female. The diagnosis was primary headaches in&#x0D; 68.4% of the patients, with tension-type headaches&#x0D; in 46.2%, migraine in 31.2%, and other primary&#x0D; headache causes in 22.5%. Among the secondary&#x0D; headaches, disorders of the cranium, neck, eyes,&#x0D; ears, nose, sinuses, teeth or other cervical structures&#x0D; accounted for 79.7%, with the most common cause&#x0D; being sinusitis. Cranial imaging was performed on&#x0D; 66.7% of the patients, of which 51.9% were identified&#x0D; with abnormal findings. 14.1% of the imaging&#x0D; results evaluated as abnormal were incidentally&#x0D; detected cerebral abnormalities with potential clinical&#x0D; significance; 10.3% were findings that were found&#x0D; incidentally and had no clinical significance. The&#x0D; treatment of these patients did not change with the&#x0D; imaging result. Another 25% were evaluated as&#x0D; extracerebral abnormality associated with headache.&#x0D; Only one patient's outcome was associated with&#x0D; headache. The patient was diagnosed with sinus vein&#x0D; thrombosis and the treatment was arranged.&#x0D; Conclusion&#x0D; The majority of childhood headaches identified in&#x0D; the present study were found to be benign, with the&#x0D; leading causes being tension-type headache, infection&#x0D; and migraine, and imaging methods were found to&#x0D; be of little diagnostic benefit. It was concluded that&#x0D; a detailed clinical assessment of patients presenting&#x0D; with headaches could clarify the etiology, while&#x0D; imaging methods may be useful in selected cases.

Ocular Findings in Children with Headache

ABSTRACT Purpose To determine the prevalence of ophthalmological findings suggesting an ocular cause for headache or occult neurological disease, among children with headache. Methods Retrospective cross-sectional study on children with headache at a tertiary outpatient ophthalmology clinic. All children underwent sensorimotor, anterior segment, and dilated fundoscopic examinations, with or without cycloplegic refraction. Prevalence of one or more new findings of ocular or occult neurological cause of headache, including glaucoma, uveitis, optic nerve elevation, or possible asthenopia from strabismus or refractive issues. Headache characteristics and associated symptoms were evaluated as risk factors for ocular findings. Results Among 1,878 children with headache (mean age 10 yrs, range 2–18), 492 (26.1%, 95% CI 24.3–28.2%) children had one or more new ocular findings that could cause headache or indicate intracranial disease: refractive issues (342, 18.2%), strabismus (83, 4.4%), optic nerve elevation (51, 2.7%; 26 with papilledema, 25 with pseudopapilledema), uveitis (6, 0.3%), and glaucoma (2, 0.1%). Shorter headache duration was associated with ocular findings (p = .047), but headache frequency, photophobia, nausea/vomiting, and visual changes were not. In univariable analysis, visual changes (p ≤ .001), nausea/vomiting (p ≤ .002), and morning headache (p = .02) were associated with optic nerve elevation. Conclusion An ophthalmologic examination including cycloplegic refraction is indicated in children with headache, as one-quarter have a treatable ocular condition, which may be related to the headache, or sign of intracranial pathology. While nausea, visual changes, or morning headache should raise concern, coincident visual, ocular, or systemic symptoms are not reliable predictors of discovering ocular pathology in a child with headache.

Assessment of Parenting Attitudes by Children and Adolescents with Migraine

Purpose: We aimed to investigate the parenting attitudes reported by patients and their relationships with the characteristics of headaches in children and adolescents with migraine. Methods: We conducted a retrospective review of medical records of children and adolescents with migrainous headaches (n=115; 59.1% female; mean age, 11.89±2.00 years). Children evaluated parental attitudes using the Parenting Attitude Test-Youth (PAT-Y), which comprises eight subscales and four newly devised secondary subscales. Headache severity was calculated by the visual analog scale (VAS), monthly frequency (MF), and VAS×MF/4 (VF). The scores of PAT-Y subscales and the correlations between PAT-Y scores and headache severity were analyzed by age group and sex. Scores for children’s depression inventory, childhood behavior checklists, and an attention deficit hyperactivity disorder scale were also analyzed. Results: In the elementary school age group, VAS was weakly negatively correlated with the “achievement press” (r=–0.28, P&lt;0.05) and “high expectation” (r=–0.25, P&lt;0.05) attitudes, and VF was weakly negatively correlated with “achievement press” (r=–0.32, P&lt;0.05), “punishment” (r=–0.27, P&lt;0.05), and “high expectation” (r=–0.29, P&lt;0.05). In the middle-school age group, MF and VF were moderately positively correlated with the “achievement press” attitude (r=0.48, P&lt;0.01 and r=0.48, P&lt;0.01, respectively), VF was weakly positively correlated with the “neglectful” attitude(r=0.31, P&lt;0.05), and MF was weakly positively correlated with scores for depression (r=0.29, P&lt;0.05) and internalized problems (r=0.31, P&lt;0.05). Conclusion: Parenting attitudes perceived by children and adolescents with migrainous headaches varied by age, and some parenting attitudes were related to headache severity. Education on age-appropriate parenting attitudes may help cope with migrainous headaches.

Clinical characteristics and the efficacy of Topiramate in Migraine prevention

Background: Migraine is a common disease that globally affects about 14% of the population, accounting for 1/3 of the burden of neurological disease. Topiramate is considered one of the first-line options for the prevention of Migraine because of its optimal benefits. Therefore, Vietnam in general and the Mekong Delta, in particular, need more studies to clarify the clinical symptoms of Migraine and evaluate the effectiveness of Topiramate in the treatment of migraine headaches. Objectives: To describe the clinical characteristics of migraine headaches and to evaluate the efficacy and safety of topiramate for migraine prevention. Materials and methods: A cross-sectional descriptive study and clinical intervention without a control group of 70 patients diagnosed with Migraine headaches. Study participants were evaluated for clinical characteristics of Migraine and Topiramate treatment was initiated at 50 mg/day. The primary efficacy measure was defined as ≥ 50% reduction in monthly migraine frequency after 4 weeks, 8 weeks, and 12 weeks. Results: The ratio of female/male: 3/1; mean age 43.5±12.3; the mean age of Migraine onset was 38.9 ± 10.3 with the mean monthly number of Migraine episodes (28 days) being 4.7 ± 1.5. The effective rate of Topiramate in the treatment of Migraine is 86.4%, specifically at doses of Topiramate 50mg, 100mg, 200mg, 40%, 30.5%, and 15.9%, respectively. The main side effects of the drug are weight loss (52.5%), loss of appetite (25.4%), paresthesia (22.1%). There were no serious adverse events or death. Conclusions: Migraine mainly affects women (757%), the age of onset is usually middle-aged. Topiramate treatment at daily doses of approximately 50mg resulted in statistically significant improvements in mean monthly Migraine. Topiramate is safe and well- tolerated in patients with Migraine headaches.

Relationship between Self-Efficacy and Headache Impact, Anxiety, and Physical Activity Levels in Patients with Chronic Tension-Type Headache: An Observational Study.

Background Chronic tension-type headache is the primary headache with the highest prevalence. The present study is aimed at analyzing the associations between patient self-efficacy and headache impact with pain characteristics, kinesiophobia, anxiety sensitivity, and physical activity levels in subjects with chronic tension-type headache. Materials and Methods An observational descriptive study was carried out. A total sample of 42 participants was recruited at university environment with diagnosis of tension-type headache. Headache characteristics (frequency, intensity, and duration), physical activity levels, pain related-self-efficacy, kinesiophobia, anxiety sensitivity, and headache impact were measured. Results The HIT-6 (61.05 ± 6.38) score showed significant moderate positive correlations with the ASI-3 score (17.64 ± 16.22; r = 0.47) and moderate negative correlations with the self-efficacy in the domains of pain management (31.9 ± 10.28; r = −0.43) and coping with symptoms (53.81 ± 14.19; r = −0.47). ASI-3 score had a negative large correlation with self-efficacy in the domains of pain management (r = −0.59), physical function (53.36 ± 7.99; r = −0.55), and coping with symptoms (r = −0.68). Physical activity levels showed positive moderate correlations with the self-efficacy in the domain of physical function (r = 0.41). Linear regression models determined that the self-efficacy and anxiety sensitivity with showed a significant relationship with the HIT-6 score (R2 = 0.262; p = 0.008) and with the ASI-3 score (R2 = 0.565; p < 0.001). In addition, no correlations were found between pain intensity, duration or frecuency with psychosocial factors, or headache impact. Conclusions The present study showed that patients with chronic tension-type headache had a great negative impact on daily tasks and physical activity levels, which were associated with higher anxiety levels and lower self-efficacy.

The impact of the COVID-19 pandemic on patients with tension-type headache: A multicenter survey

Background &amp; Objective: Tension-type headache (TTH) is the most common primary headache. TTH worsens quality of life and is related to various psychosocial factors. We aimed to examine the severity of headache (intensity, frequency, and duration), analgesic use, quality of life (QoL), and the impact of COVID pandemic-induced stress in TTH patients. Methods: TTH cases seen at neurology outpatient clinics in 15 centers in Turkey were included in the study. A questionnaire incorporating sociodemographic and medical information, headache features, sleep quality, general quality of life, and impact of the pandemic event was administered to the subjects. Results: A total of 975 TTH patients were evaluated. Headache severity was higher in women as well as in patients with a history of COVID-19 contact. Women, those with chronic diseases, and cases with a COVID-19 contact history had worse perceptions of quality of life and were affected to a greater extent by the pandemic. The factors affecting the impact of the pandemic were female gender and difficulty in access to health services for headache. Co-existing chronic diseases and lost productive time due to headaches were negative determinants for both QoL and the impact of the pandemic. Conclusion: Our results show that the COVID pandemic severely worsened the headache burden, quality of life and mental health of TTH patients. These findings can guide us in the clinical approach to TTH cases.

Clinical pattern and response to treatment of primary stabbing headache: Retrospective case series study from a Portuguese tertiary hospital.

This retrospective case series study aimed to investigate the demographic and clinical patterns of primary stabbing headache (PSH). In addition, we tried to identify subgroups of treatment responses in a neurology outpatient consultation at a Portuguese tertiary hospital. Clinical records were retrospectively reviewed and patients meeting the International Classification of Headache Disorders, 3rd edition, criteria for PSH were identified from January 2014 to December 2020. We collected data regarding demographic characteristics, clinical features of the headache, primary headache comorbidities, and information about treatment-related do PSH. Of 1857 patients, 32 (1.7%; mean [SD] age of onset 56[3.5]years) had the final diagnosis of PSH. Regarding headache characteristics, 20 patients (62.5%) reported episodes of stabbing in fixed locations and 12 (37.5%) in multiple areas; the duration of each attack was between ≤5 s (seven [21.9%]), 5-60 s (20 [62.5%]), and ≥60 s (five [15.6%]). In all, 18 patients (56.3%) had an episodic course (vs. six of 32 [18.8%] an acute course and eight of 32 [25%] a chronic course). In all, 17 patients started medical treatment (53.1%), with total or partial improvement in 10 (58.8%) of them. It was found that patients with pain in fixed locations had a better response to treatment when compared to patients with multiple locations, in a statistically significant way (eight of 11 vs. two of six, p= 0.023). In our sample, the mean age of onset of PSH was >50 years and there was a wide range of PSH duration. The duration of each attack (>5s), the pain in fixed locations, non-daily episodes of the pain in each attack, and the intermittent course of headache were the most prevalent clinical features. Finally, patients with stabbing in localized areas had a better response to treatment.

Epidemiological aspects of headache after different types of COVID‐19 vaccines: An online survey

BackgroundCoronavirus disease 2019 (COVID‐19) vaccine–related side effects are a key concern with the emergence of various types of vaccines in the market. We aimed to assess the frequency and characteristics of headache following different types of COVID‐19 vaccines.MethodsFully vaccinated people were recruited by a convenience sample through an online survey from September 1 to December 1, 2021. Detailed analysis of headache following vaccination was investigated. Participants with a history of pre‐existing headaches were telephone interviewed by a neurologist to ascertain the type of headache.ResultsA total of 1372 participants participated (mean age 32.9 ± 11.1). The highest frequency of headache was reported with the adenoviral vector type (302/563, 53.6%), followed by mRNA vaccines (129/269, 48%) and then the inactivated type (188/540, 34.8%). Recipients of the adenoviral vector type had a significantly longer latency between vaccination and the headache onset (median 8 h [5:12]) than recipients of the inactivated type (median 4 h [2:8], p < 0.001). Headache intensity was significantly higher with the adenoviral vector type (median 6 [5:8]) than with the inactivated type (median 5 [4:7], p < 0.001). Adenoviral vector vaccines would increase the likelihood of headache by 2.38 times more than inactivated vaccines (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.83–3.04, p < 0.001). Female sex and thyroid disease were significantly associated with headache related to COVID‐19 vaccines (OR 1.52, 95% CI 1.16–1.99; OR 3.97, 95% CI 1.55–10.2, respectively).ConclusionRecipients of the COVID‐19 vaccine should be counseled that they may experience headaches, especially after the adenoviral vector type. However, the intensity of such headache is mild to moderate and can resolve within a few days. Based on the current study design and the potential recall bias, these results may not be generalizable and should be preliminary.

Pediatric Headache Experience During the COVID-19 Pandemic.

ObjectiveHeadache disorders are exceedingly common in children and adolescents. The association between headaches, emotional stress, and disruptions in daily routines are well established. The goal of this study is to compare the experiences of patients with a preexisting diagnosis of a primary headache disorder in terms of headache frequency and severity, lifestyle techniques for headache prevention, screen use, and mood from before and after the onset of the COVID-19 pandemic.MethodsPatients evaluated by the Headache Clinic at Children’s National Hospital between Summer 2020 and Winter 2021 were enrolled in a patient registry. Patients completed a questionnaire examining changes in headache characteristics and lifestyle factors since the onset of the COVID-19 pandemic.ResultsA total of 107 patients completed the survey. Since the pandemic’s onset, patients reported decreased physical activity (n = 59, 55%), increased frequency of chronic headaches from 40% (N = 42) to 50% (N = 54), and increased constant daily headaches from 22% (n = 24) to 36% (n = 38). Patients reported worsened anxiety (n = 58, 54%), mood (n = 50, 47%), and workload (n = 49, 46%). Sixty-one percent (n = 65) of patients reported using screens for school for more than 6 hours per day. The majority (n = 67, 63%) of patients indicated that they would prefer attending in-person school, with 14% (n = 15) responding that they preferred online school.ConclusionSince the COVID-19 pandemic’s onset, pediatric headache patients have experienced increasing headache frequency, worsening anxiety and mood, decreased physical activity, and increased screen usage. Although this study is limited by sample size and observational design, future population-based studies will further elucidate the impact of this pandemic on pediatric headache.

Sex-related differences in cluster headache: A hospital-based study in Taiwan.

To compare the clinical profiles between male and female cluster headache patients from a large cohort. This hospital-based study enrolled patients diagnosed with cluster headache between 1997 to 2021. Participants completed structured questionnaires collecting information on demographics, clinical profiles, and quality of life. Treatment regimens and effectiveness were determined through medical chart review. All variables were compared between the sexes. In total, 798 patients (M/F:659/139) were enrolled. The male-to-female ratio was 4.7:1 for the full study period, but it declined from 5.2:1 to 4.3:1 for patients enrolled before and after 2010, respectively. The frequencies of chronic cluster headache (M:1.2%, F:1.4%) and aura (M:0.3%, F:0.7%) were low but similar between the sexes. Most headache features showed no difference between men and women. Female patients had significantly longer attack duration, shorter inter-bout duration, higher frequencies for eyelid edema, nausea and vomiting and lower frequencies for conjunctival injection and pacing. Sex difference did not influence headache-associated disability, anxiety, or depression, but poor sleep quality was significantly more common in women. Among menstruating women, 22/122 (18.0%) reported worsening headaches during menses. The effectiveness of treatment was similar between the sexes. Despite a decline of male-to-female ratio in the past two decades, most clinical profiles were similar between the sexes.

Not Simply a Structural Problem: Psychological Determinants of Headache in Patients with Tumors of the Sellar Region.

Headache in patients with tumors of the sellar region (TSR) has previously been attributed entirely to biomechanical causes. This study aimed to investigate the influence of psychological determinants for the occurrence of and disability due to headaches in patients with TSR. This was a cross-sectional single-center study with a logistic regression approach. Eighty-four patients (75%) with pituitary adenomas and 28 with other TSR prior to first-time neurosurgery were investigated. One-hundred and twelve patients received standardized questionnaires on personality, headache characteristics, and disability due to headache. Fifty-nine patients additionally filled in questionnaires about coping with stress and pain catastrophizing. Separate logistic regression models were used to predict the risk of headache occurrence and disability due to headache by personality, stress coping, and pain catastrophizing. Conscientiousness, neuroticism, and pain catastrophizing were significant predictors of headache occurrence. The amount of explained variance for both models predicting headache occurrence was comparable to that in primary headache. Neuroticism, pain catastrophizing, and humor as a coping strategy predicted disability due to headache with a high variance explanation of 20-40%. For the first time, we report data supporting a strong psychological influence on headache and headache-related disability in patients with TSR, which argue against purely mechanistic explanatory models. Physicians treating patients with TSR and headaches should adopt an integrative diagnostic and treatment approach, taking the biopsychosocial model of pain into account.